Term Natural Delivery without Complications in a Pregnant Woman with Bladder Exstrophy: A Case Report

Document Type : Case report

Authors

1 Professor, Department of Obstetrics and Gynecology, Fellowship of Gynecology Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Resident of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident Fellowship of Gynecology Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Bladder exstrophy is a rare congenital anomaly due to midline anterior abdominal wall defect, causing a series of genitourinary and muscular malformations, which demands surgical correction. Women with bladder exstrophy are fertile and able to have normal children without this disease. However, successful pregnancy and delivery is rare in females with this condition and many complications can occur. Planned Cesarean section at term is considered the most appropriate mode of delivery. In this research, a case with bladder exstrophy, who experienced natural delivery without trauma to the genitourinary system, was introduced. 
Case presentation: Our case was a 36-year-old pregnant woman with a history of multiple corrective surgical procedures due to bladder exstrophy, who referred to the hospital with labor pain and rupture of members at 39 weeks of gestation. She had a successful vaginal delivery without complications with the use of sublingual misoprostol and intravenous oxytocin.
Conclusion: Although cesarean section is the most common mode of delivery for pregnant women with bladder exstrophy, it could be associated with risks, including multiple pelvic adhesions due to several corrective surgeries. Therefore, natural vaginal delivery with proper monitoring can be an appropriate method for pregnancy termination in this disease.

Keywords

References

  1. Rose CH, Rowe TF, Cox SM, Malinak LR. Uterine prolapse associated with bladder exstrophy: surgical management and subsequent pregnancy. J Matern Fetal Med 2000; 9(2):150-2.
  2. Ludwig M, Utsch B, Reutter H. Genetic and molecular biological aspects of the bladder exstrophy-epispadias complex (BEEC). Urologe A 2005; 44(9):1037-8.
  3. Tayman C, Bayrak Ö, Şahin MA. Mesane Ekstofili Bir Olgu. Tıp Araştırmaları Dergisi 2008; 6:48.
  4. Reutter H, Qi L, Gearhart JP, Boemers T, Ebert AK, Rösch W, et al: Concordance analyses of twins with bladder exstrophy-epispadias complex suggest genetic etiology. Am J Med Genet A 2007; 143A(22):2751-6.
  5. Ludwig M, Rüschendorf F, Saar K, Hübner N, Siekmann L, Boyadjiev SA, et al. Genome-wide linkage scan for bladder exstrophy-epispadias complex. Birth Defects Res A Clin Mol Teratol 2009; 85(2):174-8.
  6. Catti M, Paccalin C, Rudigoz RC, Mouriquand P. Quality of life for adult women born with bladder and cloacal exstrophy: a long-term follow up. J Pediatr Urol 2006; 2(1):16-22.
  7. Rytlewski K, Grzyb A, Urbanowicz W. Pregnancy in a woman after eight reconstructive urological operations due to bladder exstrophy: case report. Clin Exp Obstet Gynecol 2005; 32(4):251-3.
  8. Ebert AK, Falkert A, Hofstadter A, Reutter H, Rosch WH. Pregnancy management in women within the bladder-exstrophy-epispadias complex (BEEC) after continent urinary diversion. Arch Gynecol Obstet 2011; 284(4):1043-6.
  9. Wittmeyer V, Aubry E, Liard-Zmuda A, Grise P, Ravasse P, Ricard J, et al. Quality of life in adults with bladder exstrophy-epispadias complex. J Urol 2010; 184:2389-94.

Hensle TW, Bingham JB, Reiley EA, Cleary-Goldman JE, Malone FD, Robinson JN. The urological care and outcome of pregnancy after urinary tract reconstruction. BJU Int 2004; 93(4):588-90. 

The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 21, Issue 3
May 2018
Pages 103-108

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